HomeMy WebLinkAbout0099 GOOSEBERRY LANE - Health "99. Gooseberry Lane
Marstons Mills F/R
A = 102 063
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Commonwealth of Massachusetts I 4P3 r
a=1 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
W- 99 Gooseberry Ln 1>
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is ^7
required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in an"i'
way. Please see completeness checklist at the end of the form.
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
P.O. Box 73
Company Address
E. Falmouth MA 02536
City/Town State Zip Code
1-508-495-0905 S 13971
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000).The system: '
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
1-5-17
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
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Commonwealth of Massachusetts
�q, Title 5 Official Inspection form
f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
� �FJ
�_s� ✓ 99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
System is in good working order with no sign of failure.
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
• ,❑ Y ❑ N ❑ ND (Explain below):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
i
r
Commonwealth of Massachusetts
as Title 5 Official Inspection Form
ILI
' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
99 Gooseberry Ln
Property Address '
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
i
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:'
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts` ,
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
��1;!✓ 99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑' The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
'*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes"or"No"to each of the following for all inspections:
Yes 'No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
E ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
1
-� Commonwealth of Massachusetts
G Title 5 Official Inspection Form
ill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-'2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy,is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd. I
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
If you have answered yes to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts. '
f Title 5 Official Inspection Form
-� Subsurface Sewage Disposal System,Form -Not for Voluntary Assessments
99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
1 ❑' ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ -Was the site inspected for signs of break out?
® ❑ •Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information,on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑• Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR-15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
r Commonwealth of Massachusetts '
r Title 5 official Inspection Form
' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 p Y rY
a
99 Gooseberry Ln
Property Address u�
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Unknown
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
;r
Commonwealth of Massachusetts
a Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
J!✓ 99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: N/A
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: j
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
:a Title 5 Official Inspection Fora
- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
2003
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 42"feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Good condition.
Septic Tank (locate on site plan):
Depth below grade: 36"feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 gal
Sludge depth:
12"
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
�R F� Title 5 Official Inspection Form
N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
99 Gooseberry Ln
Property Address
Bank Owned_ (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
20"
Scum thickness
1"
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
15"
How were dimensions determined? Tape
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank is in good condition with baffles installed and no sign of leakage.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
I
Date of last pumping: Date
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
- Commonwealth of Massachusetts
Title 5 Official Inspection Fora
-� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts '
:a=1 Title 5 Official Inspection Form
' Subsurface Sewage Disposal System Form -Not for,Voluntary Assessments
�,F;
�_sf 99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Good condition with water at working level and no sign of back-up from field..
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
i
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
gill
f Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required.for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number:
2-500's
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number„dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach chambers in good condition and empty at inspection with no visible stain lines.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
tins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
�aa Title 5 Official Inspection Form
f
Subsurface Sewage Disposal System Form Not for,Voluntary Assessments
�_�.1;!✓ 99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17'
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
: Title 5 Official Inspection Form
..�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
%1
;4J 99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
. r
.3 v
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
f� Title 5 Official Inspection Form
�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed- Date
® Observed site (abutting property/observation hole within 150 feet of SAS
® Checked with local Board of Health -explain:
® Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
Original design plans show no groundwater at 12'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
,a=1 Title 5 Official Inspection Fora
' N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
99 Gooseberry Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 1-5-17
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
TOWN OF BARNSTABLE
LOCATION �6iW se l"." L SEWAGE #
VILLAGE Al/,//��5 �• ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 6L, /f o V-
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) Pe4O (size)
NO.OF BEDROOMS 3
BUILDER OR OWNER ' /`4 ; /
PERMTTDATE: c7 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �y Feet
Private Water Supply Well and Leaching Facility (If any wells exist
. on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
3�
o0
TUWN. EARN TABLE
LGATii?N
G� SEWAGE`#
YlI,LA S ASSESSOWS'INW A LQT
INS 'P�t.LER'S tARt£c4'PYi01+?E 4
SS TANK CAIaAQTY
PTO:`t3F BFI3�COMS 3
BUII DER:.4Ii OWi*tER <.
P OffDATE Ct3IvEQT:fAtdCE DATE;
E Separauon Distance Between Ebe
D�rlax;mum Adjusted Groundwater Table to the$ottom of Leaching FaCi�Zty Fee4
Pnvafe V�latee.Supply;Well aAd I.eacwg�*acaiity (If any}vI#s exist
�n:sits or wutun?AQ feet.of lesg fY) � . Feet :.
Edge of i�letand and Leaching Faa'lity(If ariy wetlands exist
wittun 3o0'feet}feactung lactliry} / iFeet
O 3
a _ z13y-, d6
14 13 " 4/l "
l
No. �C)3—b� - Fee
Z
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Rppfiratton for 33igozal *p!Aem Con5trurtton Permit
Application for a Permit to Construct( )Repair( )Upgrade(V)Abandon( ) O Complete System &/Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
AssessoFOs2 apt
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size 7 7Ssq.ft. Garbage Grinder(WO
Other Type of Building 5 ,re No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow Ila gallons per day. Calculated daily flow gallons.
Plan Date Z Numbe��sheets T Revision Date
Title
Size of Septic Tank O Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) /)` e Vye
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue4by i Bo of ealth.
Signed Date
Application Approved by Date 3
Application Disapproved for the following reasons
Permit No. 2-003-066 Date Issued 2- S 03
---------------------------------------
No. 2003-0tOV` _e Ro �� t Fee SDI
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
- PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
' ZIPPYtcatton for Mtgpogar *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) El Complete System LA Individual Components
Location Address or Lot Owner No. /� 's Name,Address and Tel.No.
9�' 60os� °r'� sosd� �
Assess ''si ap/(p3
cel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size/,7 7Ssq.ft. Garbage Grinder(/�o
Other Type of Building Sal' CN No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow U12 gallons per day. Calculated daily flow ?�lam' gallons.
Plan Date 117 7ZZ.3 Number of sheets Revision Date
Title S S) /1 D
Size of Septic Tank 9-9d� ,�i1'is�` Type of S A.S.-. Z S-OD 3W
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
v
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issueWb,, i Bo d of HealthSigned �l Date 2-15 -3j'
Application Approved by Date 2-1 5 e)3
Application Disapproved for the following reasons
Permit No. 2003—U(o 0 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERT.Fy..tt tah ih -On- ite Se age Disposal System Constructed( )Repaired( )Upgraded(P )
Abandoned( )by / /```7/
at �Dl ll i has been construct d ify accordance
with the provisions of Title 5 and the for Disposal'Sy m Construction Permit No. 2t)D3-Ob 0 dated 2 S d 3
Installer .-'� Designer
The issuance of this p 1rmit shall not be construed as a guarantee that the syste w' i a 'gned.
Date C 3 Inspector
---------------------------------------
No. 2 003 —0(,b Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Mifspozal *p.5tem Consstruction Permit
Permission is hereby granted to onstruct( )Repair( )Upgrade(VI/Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Conr;t io must be completed within three years of the date of this permf.
Date:_ 2 0 3 Approved by
I
�L
TOWN OF BARNS TABLE
LOCATION 9�2el 45�wS'� ektgj L SEWAGE # -G 3�G
VILLAGES /7////5 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING -ACII.TTY: (type)
S+Cep (size) / •sJs. x
NO.OF BEDROOMS _
BUILDER OR OWNER t�
PERMTTDATE: OMPLIANCE DATE: " SLI v3
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
Feet
within 300 feet of leaching facility)
Furnished by ��� � ��sr"r ��li�s-�•xi
i
Aelall
43
'VI
I
P �
fAkILED INSPECTION
, „
COMMQNWEALTH OF MASSACHUSETTS PARCEL;
LOT
PAR ___
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
w
DEPARTMENT OF ENVIRONMENTAL PROT CTIRONCEIVED
� d
SEP 3 0 2002
Q
.�` TOWN OF BARNSTABLE
°'M SyOv ;x HEALTH DEPT.
y
TITLE 5
OFFICIAL INSPECTION'FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
. ,., PART A
CERTIFICATION
Property Address: 99 GOOSEBERRY LANE MARSTONS MILLS, MA 02648 ` (D WJ
Owner's Name: BRAIN HUTCHINSON
Owner's Address: 99 GOOSEBERRY LANE MARSTONS MILLS,MA 02648
Date of Inspection: 8/26/02
copy
Name of Inspector: (please print t• . JOHN GRACi
Company Name: SEPTIC INSPECTIONS
Mailing Address: P. .- BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 508-564-7270
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
true,accurate and complete as of the time of,the inspection.The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system
inspector pursuant to Section 15.340 of Titled.5(310 CMR 15.000). The system:
_ Conditionally Pas s '.
_ Needs Further I Iuation by the Local Approving Authority
X Fails ���
KA
Inspector's Signature:
Date: 8/26/02
The system inspector shall submit a copy o this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspection. If th system is a shared system or has a design flow of 10,000 gpd or greater,the
inspector and the system owner shall submit,the report to the appropriate regional office of the DEP. The original should be
sent to the system owner and copYies sent to the buyer, if applicable,and the approving authority.
Notes and Comments a, s; i
SYSTEM FAILED TITLE V INSPECTION:OVERFLOW WAS FULL UP TO PIPE.
****This report only describes conditions at the time of inspection and under the conditions of use at that time.This
inspection does not address ttow the system will perform in the future under the same or different conditions of use.
Fopp i
TitIF � lnc!�Frtinn Fnrm (t/1 S/?fi71(1 '�t=+„ �
t
Page 2 of I I
�4
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
., PART A
i{j{ FCERTIFICATION (continued)
Property Address: 99 GOOSEB,ERRY•LANE MARSTONS MILLS,MA 02648
Owner: BRAIN HUTCHINSON
Date of Inspection: 8/26/02
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments: ,n
SYSTEM FAILED TITLE V INSPECTION.OVERFLOW WAS FULL UP TO PIPE.
B. System Conditionally Passes:
_ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,
upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,NIND) in the for the following statements. If"not determined"please explain.
n/a The septic tank is metal and over,20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits
substantial infiltration or exfiltr4ti'8,n o�tank failure is imminent. System will pass inspection if the existing tank is replaced
with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating
that the tank is less than 20 years old is available.
ND explain: n/a
7
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed
pipe(s)or due to a broken,settled or uneven'distribution box. System will pass inspection if(with approval of Board of
Health):
broken pipe(s)are replaced
_ obstruction is removed
_ distribution box is leveled or replaced
ND explain: n/a
n/a The system required pumping more'than 4 times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval ofthe�`Board of`Health):
_broken pipe(s)are replaced
_obstruction is removed
NP explaill:
SIB.
t.
Page 3 of 11 ,. .;,
• is ;
i!a •
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
;
Property Address: 99 GOOSEBERRY LANE MARSTONS MILLS,MA 02648
Owner: BRAIN HUTCHINSON�
Date of Inspection: 8/26/02
C. Further Evaluation is Required'by'the'Board of Health:
_ Conditions exist which requireifurther,'evaluation by the Board of Health in order to determine if the system is failing to
protect public health,safety or the environment.
1. System will pass unles`46-ardo"f Health determines in accordance with 310 CMR 15.303(1)(b) that the system is
not functioning in a manner;which will protect public health,safety and the environment:
• �i
_ Cesspool or privy is within•5.0 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board:of Health(and Public Water Supplier,if any)determines that the
system is functioning in a Manner that protects the public health,safety and environment:
_ The system has a septic,tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water
supply or tributary to a sur'face water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic'tank and SASS and the SAS is within 50 feet of a private water supply well.
'r F
_ The system has a septic tank,and'SAS and the SAS is less than 100 feet but 50 feet or more from a private water
supply well". Method u:sed,to'determine distance n/a
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and
volatile organic compounds,indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy
of the analysis must be attachedtto this`form.
3. Other:
n/a 4
. t
i
'il
Page 4 of l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 99 GOOSEBERRY LANE MARSTONS MILLS,MA 02648
Owner: BRAIN HUTCHINSOIV `
Date of Inspection: 8/26/02
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for alLinspections:
Yes No
X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool.is less than 6"below invert or available volume is less than ''/z day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped LAST YEAR BY OWNER.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet-but greater than 50 feet from a private water supply well with
no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP
certified laboraibry;fo'i coliform bacteria and volatile organic compounds indicates that the well is free
from pollution froth J.hat,facility,,and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.,].
X _ (Yes/No)The system fails. I,have determined that one or more of the above failure criteria exist as described in 310
CMR 15.303,therefore the system fails.,The system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E. Large Systems:
To be considered a large system`the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or,"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ X the system is within 400 feet of a'surface drinking water supply
_ X the system is within 200`feet of a tributary to a surface drinking water supply
_ X the system is located in a'nrtrogen'sensttive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply'well
If you have answere&lyes'"to any question in Section E the system is considered a significant threat,or answered
"�Ps" in Section D ahove the Ini�e'Sj%sfci��`has filed: The rnvner rn'ohernlor of any Dirge system considered n Signific�nl Ihrent
under Section E or failed under Section}D'shalf upgrade the system in accordance with 310 CM 15.304. The system owner
should contact the appropriate regional office of the Department.
'^ d
Page 5 of I t
�A a
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
� p
Property Address: 99 GOOSEBE`RRY LANE MARSTONS MILLS, MA 02648
Owner: BRAIN HUTCHINSON
Date of Inspection: 8/26/02
Check if the following have beentdone:Nou'must indicate"yes" or"no"as to each of the following:
Yes No
X _ Pumping information was provided'+by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks
X _ Has the system received normal flows in the previous two week period '?
_ X Have large volumes of water'been introduced to the system recently or as part of this inspection?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelliang insoect�d for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS, located on site'?
X _ Were the septic tank manhole§'uncovered,opened,and the interior of the tank inspected for the condition of the
baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
X _ Was the facility owner-.,(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal sysfems? ``
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
X _ Existing information. For example,a plan at the Board of Health.
X _ Determined in the fifeld(if any'of the failure criteria related to Part C is at issue approximation of distance is
unacceptable) [310 CMR 15.302(3)(b)J
Page 6 of 11 ,
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 99 GOOSEBERRY LANE MARSTONS MILLS,MA 02648
Owner: BRAIN HUTCHINSON
Date of Inspection: 8/26%02
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design)'. 3 :Number of,bedrooms(actual): 3
DESIGN flow based on 310 CMR;T5'203 (for'example: 1 10 gpd x#of bedrooms): 330
Number of current residents: 5 .'m..,.
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes dr;no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)): Wa- d I -L09 iDLYD
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIA'L `
Type of establishment: n/a
Design flow(based on 310.C.MR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to'`the Title 5 system (yes or no): NO
Water meter readings, if available:Nn/a
Last date of occupancy/use: n/a .
OTHER(describe): n/a .
ir -
GENERAL INFORMATION
Pumping Records
Source of information: LAST YEAR,BY OWNER
Was system pumped as part of the inspection(yes or no): NO
If yes, volume pumped: n/agallons-=`How was quantity pumped determined? n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes;attach,previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from
system owner) t
_Tight tank Attach a copy oFfhe DEP apprIoval
Other(describe): n/a
Approximate age of all components;date installed(if known)and source of information:
0 YFAI(S I1Y OIVNER
Were sewage odors detected when arriving at the site(yes or no): NO
6
Page 7 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 99 GOOSEBERRY LANE MARSTONS MILLS,MA 02648
Owner: BRAIN HUTCHINSO_N „
Date of Inspection: 8/26/02
BUILDING SEWER(locate on site plan)
Depth below grade: 20"
Materials of construction:_cast iron =40 PVC Xother(explain): ORANGEBURG
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 14"
Material of construction: Xcoiicrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is agelconfirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: 6' X 6' BLOCK CESSPOOL".,
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle: 31"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to trotiom of outlet tee or baffle: 17"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage, etc.):
CESSPOOL IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY
TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP:_(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of'outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping reconunei dations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related
to outlet invert,evidence of leakae'etc.): .
g, ,
.i
T
Page 8 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 99 GOOSEBERRY LANE MARSTONS MILLS, MA 02648
Owner: BRAIN HUTCHINSON
Date of Inspection: 8/26/02
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a ;
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons t
Design Flow: n/a gallons/day '
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX: _(if present must be,opened)(locate on site plan)
Depth of liquid level above outlet invert: n/a-;
Comments(note if box is level and distributiotn`o to outlets equal,any evidence of solids carryover, any evidence of leakage into
or out of box,etc.): i3
NO D-BOX
PUMP CHAMBER: _(locate on site plan)
Pumps in working order(yes or no)-`NO
Alarms in working order(yes or no):NO
Comments(note condition of pumpz chamber,•condition of pumps and appurtenances,etc.):
n/a
lo
. 4
t3
� R
Page 9 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
,SYSTEM INFORMATION(continued)
Property Address: 99 GOOSEBERRY LANE MARSTONS MILLS,MA 02648
Owner: BRAIN HUTCHINSON
Date of Inspection: 8/26/02
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
R.
Type
n/a leaching pits, number: n/a
n/a leaching chambers, number: n/a
n/a �'; leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
6' X 6 BLOCK CESSPOOL overflow cesspool, number: 1
n/a d. A i 'innovative/alternative system
( Type/name of technology: n/a
4 =,
Comments(note condition of soil,sign§of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
SYSTEM FAILS DUE TO OVERFLOW BEING IN HYDRAULIC FAILURE. LIQUID LEVEL IN OVERFLOW IS
UP TO PIPE. SAS NEEDS TO BE GRADED.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a ;
Depth of solids layer: n/a ;
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
1 1'rt
PRIVY: (locate on site plan)__
Materials of construction: n/a Q
Dimensions: n/a
Depth of solids: n/a Al
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
•t'9t!'! I. e'
n
Page 10 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 99 GOOSEBERRY LANE MARSTONS MILLS,MA 02648
Owner: BRAIN HUTCHINSON
Date of Inspection: 8/26/02-
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.
Locate all wells within 100 feet:-Locate whe`re,public water supply enters the building.
iS. .
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Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 99 GOOSEBERRY LANE MARSTONS MILLS,MA 02648
Owner: BRAIN HUTCHINSON
Date of Inspection: 8/26/02
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 12+.feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local exe'avators, installers-(attach documentation)
NO Accessed USGS database=ekplairfs n/a
4y ,
You must describe how you established.'&high ground water elevation:
HAND AUGER- 12+ FT. t-,F, ;
N°
r
11
Commonwealth of Massachusetts
Executive Office of Enviromlental Affairs
Dept. of Environmental Protection
One winter Street'Boston Ma. 02108 .Tulin Septic
D.L.P. "Title V Septic Inspector
P.O. Box 2119
Teaticket, MA 02536
WILLIAM F.WELD (508)564-6813
Governor
ARGEO PAUL CELLUCCI
Lt.Govemor -•'`
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 99 Gooseberry Lane Marstons Mills Address of Owner: NOV
Date of Inspection: 11/21/97 (If different) ; 2 4 1997
Name of Inspector: John Grad Ruth NortonBox 161 Marslons io a.026PN0Fg,
I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) HEAITH p pSTAB(F
Company Name,Address and Telephone Number: C�
8
4 g
CERTIFICATION STATEMENT
I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
X Passes This Inspection Is based on criteria donned In Title V
code 310 CMR 16.303.My findings are of how the system is
_ Conditiona P ses performing at the time of the inspection.My inspection does
_ Needs F er valuation By the Local Approving Authority not Imply any warranty or guarantee of the longevity offhe
Fails septic system and any of Its components useful life.
Inspector's Signature: Date: 11121197
The System Inspector shall ubmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
I
INSPECTION SUMMARY:
Check A, B, C,or D:
A] SYSTEM PASSES:
x I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES:
_One or more system components need to be replaced or repaired. The system, upon completion
of the replacement or repair,passes inspection.
Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with-a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank;whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(rlYlsld 04fY7197)
` One Winter Street is Boston,Massachusetts 02108 a FAX(617)556-1049 0 Telephone(617)292-5500
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 99 Gooseberry Lane Marstons Mills
Owner: Ruth NortonBox 161 Marstons Mills Ma.02648
Date of Inspection:11f21197
_ Sewage backuD or.breakout or hiah.static water level observed.in,the distribution box is due to a broken,
or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if
(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
_The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method usedto determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
_ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
SAS is in hydraulic failure.
(revised 0412797)
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 99 Gooseberry Lane Marstons Mills
Owner: Ruth NortonBox 161 Marstons Mills Ma.02648
Date of Inspection:11121197
D]SYSTEM FAILS(continued)
Yes No
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate.nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA) or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04N7S7)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 99 Gooseberry Lane Marstons Mills
Owner: Ruth NortonBox 161 Marstons Mills Ma.02648
Date of Inspection:11r21197
Check if the following have been done-You must indicate either"Yes"or"No"as to each of the following:
,c_ — Pumping information was requested of the owner,occupant,and Board of Health.
x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
— flow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this
inspection.
x As built plans have been obtained and examined. Note if they are not available with N/A.
x The facility or dwelling was inspected for signs of sewage back-up.
x _ The system does not receive non-sanitary or industrial waste flow.
_c_ — The site was inspected for signs of breakout.
x _ All system components, excluding the Soil Absorption System, have been located on the site.
x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected
for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum.
x The size and location of the Soil Absorption System on the site has been determined based on.
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal Systens.
x Existing information. Ex. Plan at B.O.H.
x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is
unacceptable)115.302(3)(b)J
(revised 04127)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 99 Gooseberry Lane Marstons Mills
Owner: Ruth NortonSox 161 Marstons Mills Ma.02648
Date of Inspection:11121197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g•p•d./bedroom for S.A.S.
Number of bedrooms: J
Number of current residents: 2
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available:(last two(2)year usage(gpd):
rda
Sump Pump(yes or no): No
Last date of occupancy: nia
COMMERCIAL/INDUSTRIAL:
Type of establishment: nia
Design flow:9 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present:(yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: nia
Last date of occupancy: nra
OTHER:(Describe) rda
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System was last pumped In September 1997
System pumped as part of inspection: (yes or no)Yes
If yes,volume pumped: 1000 gallons
Reason for pumping: Maintenance
TYPE OF SYSTEM
x Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) ( if yes, attach previous inspection records, if any)
I/A Technology etc.Copy of up to date contract?
Other:
APPROXIMATE AGE of all components, date Installed(If known)and source information:
26 years
Sewage odors detected when arriving at the site:(yes or no) No
(revised 04127)97)
I
F
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 99 Gooseberry Lane Marstons Mills
Owner: Ruth NortonBox 161 Marstons Mills Ma.02648
Date of Inspection:11121197
SEPTIC TANK:
(locate on site plan)
Depth below grade: rda
Material of construction:x concreate_metal_FRP_Polyethylene—other(explain)
If tank is metal, list age ala . Is age confirmed by Certificate of Compliance No (Yes/No)
Dimensions: rda
Sludge depth:rda
Distance from top of sludge to bottom of outlet tee or baffle: nla
Scum thickness:rda
Distance from top of scum to top of outlet tee or baffle:nra
Distance form bottom of scum to bottom of outlet tee or baffle: rda
How dimensions were determined: nra
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
Ma
GREASE TRAP:
(locate on site plan)
Depth below grade: Na
Material of construction: _concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: rda
Scum thickness:rda
Distance from top of scum to top of outlet tee or baffle:rVa
Distance from bottom of scum to bottom of outlet tee or baffle:nla
Date of last pumping;,r_
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
rda
BUILDING SEWER:
(Locate on site plan)
Depth below grade: a:
Material of construction:_cast iron_40 PVC_other(explain)
Distance from private water supply well or suction MOO-
Diameter: 4
, r mments: (conditions of joints,venting,evidence of leakage,etc.)
(revleed 04127)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 99 Gooseberry Lane Marstons Mills
Owner: Ruth Nortonl3ox 161 Marstons Mills Ma.02648
Date of inspection:11121197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: rda
Material of construction:_concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: nra
Capacity: nla gallons
Design flow: rda alions/day
Alarm level:_nla Alarm in working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
rda
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: n1a
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.)
rda
PUMP CHAMBER:
(locate on site plan)
Pumps in working order.(yes or no)No
Alarms in working order(yes or no)_ves
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,etc.)
rda
(rev1aed0427197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 99 Gooseberry Lane Marstons Mills
Owner: Ruth NortonBox 161 Marstons Mills Ma.02648
Date of Inspection:11121197
SOIL ABSORPTION SYSTEM (SAS):x
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
nfa
Type:
leaching pits,number: rda
leaching chambers,number:Na
leaching galleries,number: rda
leaching trenches,number,length: rya
leaching fields,number, dimensions:rda
overflow cesspool,number:6'x6'block
Alternate system: rda Name of Technology:_nra
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
The leach pit la structurally sound and funclloning properly.It was empty at the time of the Inspection.There has not been more than t'In pit.
CESSPOOLS:x
(locate on site plan)
Number and configuration: one
Depth-top of liquid to inlet invert: 8"
Depth of solids layer: 1'
Depth of scum layer: o
Dimensions of cesspool: 6',6'
Materials of construction: block
Indication of groundwater: rda
inflow(cesspool must be pumped as part of inspection)
NO
Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
Main cesspool and ell components are structurally sound.Recommend pumping ey8tem every one year for maintenance.
PRIVY:_
(locate on site plan)
Materials of construction: Ne Dimensions: We
Depth of solids: rya
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
PdvyComments -
(
revised 04rt71971
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
99 Gooseberry Lane Marstons Mills
Ruth NortonBox 161 Marstons Mills Ma.02648
11/21197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references, landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
0
Pati• l of 20
(nv19ad 04f27197)
W SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
99 Gooseberry Lane Marstons Mills
Ruth NortonSox 161 Marstons Mills Ma.02648
11121197
Depth of groundwater 12•
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from design plans on record.
Observation of Site(Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check.with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(MUST be completed)
USGS Maps and Charts
(revlstdOWT197) page 10 of 10
TOP FNDN. 87.4' SYSTEM PROFILE TEST HOLE LOGS
= ACCESS COVER TO WITHIN 6" OF FIN. GRADE (Nor To SCALE)
ACCESS COVER (WATERTIGHT) TO ENGINEER: D.A. OJALA, SE
MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN, GRADE 2% SLOPE REQUIRED OVER SYSTEM 86 4' WITNESS: DAVID STANTON
RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: - 1/23/03 LpKE5i0E
FOR FIRST 2' - < 2 MIN/INCH
I7�.T 00 3' MAX. PERC. RATE - $ b
GAL SEPTIC
10,415t 3•4
y 70
TAN (H 10 ) GAS SAME 82.72' a
MIN 8 . 0 7, MC7ED0 0 0ED0E3 ;o
ptt�� 82 5 C1 CI CJ m 0 � O O a Is �-� ELEV. r- m
( 2 % SLOPE) I J ;� 6" CRUSHED STONE OR MECHANICAL ao ED 0 C1 M C) 0 [� (� (� y O„ cul 86.6, o, �
COMPACTION. (15.221 [2]) 2 M 0 � 0 C] ED � Q 0 o0 80.57 a
A
DEPTH OF FL ( 3 % SLOPE) ( 1 % SLOPE)TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE SL 5W LOCUS
INLET DEPTH 10"
6#t 10YR 3/2
OUTLET DEPTH 14"
g LOCATION MAP NO SCALE
LS
FOUNDATION--- EXIST SEPTIC TANK 20' --- D' BOX 17' LEACHING FACIL T'( ASSESSORS MAP 102 PARCEL 63
5' 38" 7.5YR 5/6 83.4'
*APPROXIMATE INVERT-ONLY. GROUND FROZEN AT
TIME OF MEASUREMENT, CONFIRM INVERT PRIOR
TO INSTALLATION OF ANY PORTION OF SEPTIC
SYSTEM.
PERC C
60"
75.6' MED/COS
2.5Y 7/6
BENCH MARK - NAIL SET IN 10"
WHITE PINE. ELEV. = 88.6
132" 75.6'
NO WATER ENCOUNTERED
I � � 100.00' � � ^� + z o •- - 79.8
+ I DER NEPD NOTES:'' SEPTIC DESIGN: GARBAGE DISPOSER IS NOT ALLOWED
M 0 ( )
+ 9 I /���ES 1 . DATUM IS APPROXIMATED FROM QUAD MAP
(- x ' � DESIGN FLOW: _3 BEDROOMS ( "0 GPD) = 330 GPD
4 2 I 2. ��I it`nrlPpl WATER IS _. EXISTING
PAVED USE A 330 GPD OESI�,N VLOvv _ ___ _.___.
16" OAK + 86, L - DRIV
r- + 79.5 SEPTIC TANK: 330 GPD ( 2 ) = 660 3: MINIMUM PIPE PITCH TO BE 1/$" PER FOOT.
4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10
i H , DECK - a 1 I USE A 1000 GALLON SEPTIC TANK (EXIST) 5. PIPE JOINTS TO BE MADE WATERTIGHT.
LEACHING: 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
W I 2(30 + 9.83) 2 (.74) = 118 ENVIRONMENTAL CODE TITLE V.
I SIDES: 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
13' + 2.
16 OAK + 86. 20' DWELLING
3 BR (''`a 30 x 9.83 74 - 218 USED FOR LOT LINE STAKING.
SEPTIC TANK LOCATION E I BOTTOM:
DWELLING 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
SHOWN AS 0000 00 �' TOTAL: 454 S.F. 336 GPD
8 84.8
APPROXIMATE ONLY �r 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
0 O ABOVE TF = 87.4 00 in I USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR
� GROUND 6'1 � o � INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
LEACH PIT LOCATION 5' POOL o ao 78.8 � EQUAL) WITH 2.5' AT SIDES, 4' AT ENDS, AND 5' FROM BOARD OF HEALTH.
UNKNOWN
car + 2.7 I BETWEEN UNITS 10, LEACH PIT TO BE PUMPED AND FILLED WITH CLEAN SAND OR
6" MAPLE I 4 I � REMOVED AS NECESSARY.
6 _-� 86.1 + I O LEGEND
I CHILD'S I LOT 41 PROPOSED SPOT ELEVATION
gpXD 10,775t SQ. FT. 7 .4 78.4 TITLE 5 SITE PLAN
SHED I 100x0 EXISTING SPOT ELEVATION OF
I6 + 85.5 x P VED
KING I 100 PROPOSED CONTOUR 99 GOOSEBERRY LANE
86.0
I -- 100 EXISTING CONTOUR IN THE TOWN OF:
MI ARN Ax X x-,--� X * s7 ( MARSTONS L LS) B ST B LE
100.00' PREPARED FOR: BORTOLOTTI
77 00 .9
M BOARD OF HEALTH CONSTRUCTION/SOTTOSANTI
MA 20 0 20 40 60 Feet
APPROVED DATE
SCALE: 1 " = 20' DATE: JANUARY 27, 2003
off 508-362-4541
fox 508 362-98W
down cape engineering, inc. ARNE H.
CIVIL ENGINEERS goy' ARNE �`yG � 0
H. CI iL v
LAND SURVEYORS ALA N 92
N .26348
939 ruin st.` yarMouth, rya 02675 s
�02--407 * H. OJALA,
P.L.S. DATE